MEDICARE: DR. CRYSTAL LYNNE HANNAN ND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath	1398	OR

General Provider Information

NPI Number	:	1396816542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRYSTAL LYNNE HANNAN ND

Provider Business Mailing Address
First Line	:	1911 MOUNTAIN VIEW LN
Second Line	:	SUITE 200
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-2382
Country	:	US
Telephone Number	:	503-357-3074
Fax Number	:	503-357-2527

Provider Business Practice Location Address
First Line	:	1911 MOUNTAIN VIEW LN
Second Line	:	SUITE 200
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-2382
Country	:	US
Telephone Number	:	503-357-3074
Fax Number	:	503-357-2527

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	12/30/2011

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